Abstract
It is a pleasure to review this book by the Italian psychoanalyst Riccardo Lombardi. He is in many ways larger than life, a true Renaissance man, thoroughly knowledgeable about psychoanalysis, Greek mythology, poetry, music, good food, and wine. (Indeed he is, in addition to his work as a psychoanalyst, a wine critic.) Lombardi is someone whose very presence is curative. He integrates bodily pleasures with the intellect and brings the essence of the body and its feelings into the clinical situation. He gets to the heart of matters, to the concrete real body. His cases demonstrate an application of Bion’s theory in practice, so sorely needed by those of us struggling to understand Bion.
Lombardi thoroughly reviews the literature pertaining to the “body” after Freud’s famous declaration that “the ego is first and foremost a bodily ego” (1923, p. 26). Seven of the ten chapters are previously published. The translation of the book, included in Adrienne Harris and Lewis Aron’s Relational Perspectives Book Series, is excellent. Lombardi is a medically trained psychiatrist who, having originally planned to follow in his surgeon father’s footsteps, learned about the important role of touch by watching his father operate. He describes how he is able to reach the most severe of psychotic patients by encouraging them to verbalize, to symbolize their inner bodily sensations, which have been cut off from the mind. He demonstrates how these concrete sensations can become experienced in the analyst’s own body.
Lombardi cites the work of the many theorists who have influenced him: Ferrari (2004) on sensation, Freud (1923) on sexuality, Bion (1962, 1967) on emotion. “Our analysands,” he writes, “confront us more and more with the risk of loss of contact with the body or even with its disappearance” (p. 14). He chides theorists who intellectualize, who “paste” theories on to the clinical context “to avoid the anxiety of the unknown or the travail of an authentic emotional transformation” (p. 8). For him, clinical observation trumps theory. Psychoanalysis is not just metaphor, but a confrontation with reality—the body.
Body-Mind dissociation originates in insufficient “maternal reverie” and goes back as far as the prenatal period. The body exists, but disappears from the mind’s horizon. It is, in Bion’s terms, “a disorganized container-contained”: “The only option left for the denied body may be just going its own way: rebellion and revenge by means of the violence of psychotic explanations, or the degeneration that takes place when the body re-surfaces threateningly with somatic illness” (p. 26).
It is an error for the analyst to work with primitive patients by focusing on the transference, a tack that will distance the patient from the very states in which he has trouble relating to his body and his most primary levels. Instead the analyst must work in the same unorganized levels of fluid, untranslatable, and potentially explosive sensations of the patient, what Lombardi calls “the somatic countertransference,” the analyst’s transference onto his own body, even outside his office.
Lombardi takes up Bion’s “psychosomatics,” giving examples from Bion’s early work in which he emphasizes that bodily sensations have meaning. Bion referred to visual power, binocular vision. One case is presented in which seeing and the gaze were experienced as intrusive and violent. In another case the patient looked at him as if he were transparent and passed him on the street as though he could not see a thing. In a chapter on intersubjectivity and the body, Lombardi comments that “a discontinuity among the worlds of sensations of emotions, and of thinking quickly comes to mean that a traditional working-through ends up being impossible” (p. 60). He credits Greenberg and Mitchell (1983) with having opened his eyes to the mutual influence of patient and analyst.
Reading and trying to understand some parts of this book proved daunting for me. Although I have written about the body for many years, it was a challenge to absorb the ideas of several theorists I was not familiar with, whose names I had not even heard. That task became more possible, fortunately, when their theories were presented through Lombardi’s clear lens. As I have noted, an important influence on Lombardi’s thinking has been A. B. Ferrari, whose work is similar to Bion’s. Ferrari conceives of the COO, the “concrete original object.” For him, the body is the starting point of mental functioning. Lombardi explains that for Ferrari “the body furnishes the constitutive elements from which are derived both the precursors of the emotions and the perceptual structures out of which the ego functions develop” (p. 79). Through the mother’s “reverie,” the body is eclipsed, “giving rise to the constitution of a mental space in which sensations and emotions can be received and recognized” (p. 79). In psychosis, the body is negated.
To my mind, the great value of this book, and a rarity in the psychoanalytic literature, is the many cases Lombardi discusses. He shows how he actually works. For example, he describes the case of Arturo, an anorectic intellectualizer who could not conceive of the concrete. To him, all was abstract. In a session, the analyst felt a rumbling in his stomach, after which the patient felt the same. The analyst experienced the bodily sensations as hallucinations, just as the patient did, as if there were no difference between them: “His language gave the impression of an infant trying to find words to express his sensory experience” (p. 90).
Lombardi attempts to identify what fosters the entry of the body and bodily sensations into the analysis. He borrows Bion’s term “defeat of thinking.” On the vertical axis there is body-mind, on the horizontal axis analysand-analyst. He illustrates how he worked with his patient Antonia so that she could maintain contact with her body and at the same time with her analyst: “this continuity of her own presence is not derived from abstract understanding, but rather from a continuous input originating in her bodily sensations” (p. 99). He presents several cases in which he shows how he works with the patient’s dreams, work in which “making room for the body as an object of the mind can help to distinguish between the body-mind relationship with an external object” (p. 104).
In a discussion of his work with adolescents, Lombardi keeps in mind Ferrari’s idea that “the adolescent’s mind does not know the body in which it lives, but must discover it” (p. 112). To work with adolescents one needs to be endowed with great empathic resources and understand one’s own adolescent experience. The hatreds and destructiveness of adolescence take time to work through.
In the chapter “Working with the Body-Mind Dissociation in Three Psychoanalytic Sessions,” Lombardi further demonstrates this work. He describes his minute-by-minute reactions to his analysand’s associations and dreams. For example, in one case he had difficulty focusing and could not “see” the dream. Then the analysand associated to a blind man. Rather than taking up the possible transference meaning of this, he showed her how he actually “saw” her as wearing socks without holes, telling her that “if you aren’t aware of your body, you can’t do what is needed to take care of it” (p. 130). For some analysts this might seem a hurtful remark. But Lombardi believes in working sternly, directly, and constantly to make connections between the analysand’s associations and his own feelings and fantasies.
Lombardi’s work is in ways similar to mine (Lieberman 2000), as I have cautioned analysts to not “rush to metaphor” when working with concrete patients concerned with their bodies. I very much agree with a warning he offers: “It does not seem a far-fetched supposition that in a state in which thought has lost its roots in bodily experience and functions on impersonal levels, a psychoanalytic working-through by means of symbolic interpretation could run a serious risk of not reaching the analysand, or even of increasing the already present dissociation” (p. 138).
He describes the relational dimension of his work as follows: “I found myself experiencing in my own person the perspective resulting from my own mental experience. Thus I made use of the relational dimension to place myself mentally inside the analysand and to try to observe—and then to encourage—her internal functioning, particularly with regard to the interaction between sensation-feeling and thought (body-mind dialogue)” (p. 140).
Renaissance man that he is, Lombardi ventures into the application of the arts, particularly music, to his clinical work. In the chapter “Bodily Claustrophobia and the Music: A Psychoanalytic Note on Beethoven’s Fidelio,” he reminds us that music reaches the most profound levels of the psyche. When there are references to music in the analysand’s communications, these usually coincide with psychic changes. Lombardi’s psychoanalysis of Fidelio will be of special interest to opera lovers. He reminds us that “familiarity with art, and music in particular, supports the construction of a contact network through which the body and mind can converse with each other, not unlike what can take place within the dreamwork” (pp. 204–205).
I have directly quoted Lombardi in a number of places. As I have noted, the translation from the Italian is excellent, and his writing is lucid. He cites the less clear writings of a number of his colleagues and is best when presenting his own cases, of which there are many. This book is a real treat for seasoned analyst and student alike. In addition to my own work on the body, I refer readers to the works of Balsam (2012) and Lemma (2015), who refer to the real body of the analysand using different theoretical models. The references are thorough and should be of considerable value to the analyst wishing to know more about “the body” in clinical work.